Habit Reversal for Impulse-Control Disorders

Habit reversal training is a method used to treat impulse control disorders. For the last 40 years, habit reversal training has been used to help people who suffer from impulsive nail biting, hair pulling, skin picking and tics, substantially reduce or stop their behavior. In at least one study, treatment with habit reversal training reduced hair pulling by 90% in participants. These positive results have recently led experts to expand its application. Habit reversal training is now being used to treat other impulse control disorders like excessive shopping, Internet addiction, and gambling addictions.

What Are Impulse Control Disorders?

Impulse control disorders are those characterized by an inability to resist impulsive acts or behaviors that may be harmful to oneself or others. There is usually an increase in tension and anxiety before the behavior manifests, or when it is resisted. This is followed by a sense of pleasure, gratification and/or release of built up tension after the behavior has been carried out.

It should be noted that impulsiveness and compulsiveness are different types of behavior. Compulsions are generally habitual in nature, characterized by actions that are repetitive or ritualistic. Impulsive behaviors, on the other hand, tend to be goal directed or pleasure/sensation seeking; pleasure is derived from the act.

When Compulsive and Impulsive Behaviors Co-Occur

Some disorders can be both compulsive and impulsive. For instance, in addition to impairment, loss of control and stress triggers, gambling addictions contain both compulsive and impulsive aspects.

Compulsion: Repetitive behaviors in gambling and triggers to gamble; ritual, usually illustrated by clothing, or “lucky charms” used while gambling

Impulsiveness: Sensation seeking; pleasure is derived from the act of gambling

Experts have explored the efficacy of habit reversal training for treatment of obsessive-compulsive disorder (OCD) as well, since many disorders that focus on compulsions also have impulse control aspects. And, many disorders that began as impulse control issues can become habitual over time as tolerance to sensation builds.

How Does Habit Reversal Training Work?

Habit reversal training has been shown to help with impulse control disorders by teaching individuals coping skills to manage their behaviors. The first step is teaching individuals to monitor their behavior until they become aware of when it’s about to happen, or is happening. Individuals are then taught to develop a competing response to replace the problem behavior. The competing response acts as a substitute behavior for the problematic one and the problem behavior is controlled or prevented by the substitution. Lastly, individuals learn skills to promote relaxation and relieve anxiety and tension built up by their inability to engage in the problem behavior.

For decades, experts have been using habit reversal training successfully to treat impulse control disorders like hair pulling and tics. Recently, professionals have begun applying habit reversal training as a treatment option in gambling addictions, since these have now been formally recognized as an impulse control disorder. However, because these expanded applications of habit reversal training are more recent, it may be some time before we know how successful they are.

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